HomeMy WebLinkAboutPermit Plumbing 1999-08-09.,IDENTIAL
ERMIT APPLICATION
lnspections: 726.3769
Office: 726-3759 |
LOCATION OF PROPOSED WORK:
ASSESSOFIS MAP:
LOT:
PFlINGFIELD
7hv
JOB NUMBEB o8
225 Fifth Street
Springfleld, Oregoo 97 477
TAX
)77
BLOCK:SUBDIVISION
PHONE:
STATE:ztP
rd 06T)o s De-- /{o b Tn<--.72aOWNER:
ADDRESS:
CITY:
ADDITION DEMOLISH OTHER
DESCRIBE WORK:
NEW- REMODEL X
ADDRESS
ELECTRICAL:
EXPIRES ,f PHONE
-5s7{
CONTBACTOR'S NAME
PLUMBING:
GENERAL:
CONST.
CONTFIACTOR #
# o F B LDGs: THTSPERMIT SH/^ " trXPlpg lFffi@dopted @ttltftl@@Qft utility-/ar itr,l\ ilUl{:Urgg FLOOD })LAIN:
orl law requrres you to
Notif ication Genter. Thpse rg lqs^arc set forth
--1 nrQflf;!$ffi[ 1 -00 1 0 th fou g-riOAH g5z{0-FES@NDqhE&ronr
cal
on
occY G Bo U pW THIS PEiRMHTS]tOf,e'
# OF STORI RCE: oggg_ye+f,ay
thecenter. (wArER H EArEA!'{flqq !AY!EEIoP.RANGE:
- OFFICE USE -
OUADAREA:ffi LANDLISE:
To request an lnspection, you must call 726-3769. Thls ls a 24 hour recordl re 7:00 a.m. wlll be
made the sarne working day, lnspections requested after 7:00 a.m, will be made the following work day,
REQUIRED INSPECTIONS
Temporary Electric Rough Mechanical - Prior to
cover.x Final Plumbing - When all
plumblng worl( is complete.
SIte lnspection - To be made
after excavatlon, but prior to
setting forms.
[-l Rough Electrical - Prior tot-J cover-Flnal Electrlcal - When all
electrical work ls complete.
Underslab Plumbing/ Electrical /
Mechanlcal - Prlor to cover.Electrical Service - Must be
approved to obtain permanent
electrlcal power.
Final Mechanical - When all
mechanlcal work ls complete.
Footlng - After trenches are
excavated.Flreplace - Prlor to faclng
materlals and framing lnsp.
Final Building - When all
required lnspectlons have been
approved and building is
completed.Masonry - Steel locatlon, bond
beams, groutlng.
Foundatlon - After forms are
erected but prior to concrete
placement.
Other
Wall/Celting lnsulatlon - Prlor to
cover.
Underground Plumbing - Prior
to fllllng trench.l-l Drywall - Prlor to taplng.
MOBILE HOME INSPECTIONS
Underlloor Plumblng/ Mechanlca!
- Prior to lnsulatlon or decklng.Wood Stove - After lnstallatlon.
Post and Beam - Prior to floor
lnsulatlon or decklng.lnsert - After flreplace approvgl
and lnstallatlon of unlt.
Blocking and Set.Up - When all
blocklng ls complete.
Floor lnsulation - Prior to
decking.Curbcut & A1:proaclr - After
forms are ert,,cted but prior to
placement of concrete.
Plumtring Connections - When
home lras been connected to
water and sewer.
Sanitary Sewer - Prior to fllling
trench.Electrical Connection - When
blocking, set-up, and plumbing
lnspections have been approved
and the home is connected to
the service panel.
tr
Storln Sewer '- Prior to filling
trench.
Water Line - Prlor to filling
trench.
Sidewalk & Driveway - After
excavation ls complete, forms
and sub-base material in place.
l-l Fence - When coi''ipleted
litreet Trees - When atl required
trees are Planted.
Final - After all required
inspections are approved and
porches, skirting, decks, and
ventlng have been installed.
af7
9zvz
C,
E
E
tl
E
tl
tl
E
E
E
Rough Plumbing - Prior to
cover.
fl
fl
fl
tl
l-l Framlng - Prior to cover,
tl
E
Lot faces
Lot sq. ftg.
Lot coverage
Topography
Total helght
". :.; :;r-
rl ,
Lot Typr
v
-
lnterlor
-_ Corner
-
Panhandle
-
Cul-de-sac
'S THE PROPOSED WORK IN- r.
-HtsToRtcAL DlsTRlcT, oR oN
THE HISTORICAL REGISTEFI?
-
lf yes, this applicatlon must be slgned
arrd approved by the Historlcal
Coordinator prlor to permit issuance.
APPFIOVED:
PL.HSE ACCGAR
N
S
E
k
VALUE
(A)
lvir
Total Value
Building Permit Fee
State Surcharge
Total Fee
FT. X S/SQ. FT.
BUILDING PER
ITEM SQ.
Main
Garage
Carport
This permit is granted on the cxpress condition that the said
constructlon shall, in all respects, conform to the Ordinance
adopted by the City of Springfield, includtng the
Development Code, regulating the construction and use of
buildings, and may be suspended or revoked at any time
upon violation of any provisions of said ordinances.
Beceipt Number:_
Plans Reviewed By Date
BU I LDI NG
AND BUIL DIN
lUe, i5lnN cHEcK
G PERMIT
Plan Check Fee:
Date Paid
Fleceived By:
SYSTEMS DEVELOPMENT CHARGE (SDC)
(B)
Systems Development Charge is due on all undeveloped
properties within the City limits which are being improved.
ITEM
Fixtures
Residential Bath(s)
Sanitary Sewer
Water
Storm Sewer
Moblle Home
FEE
N'
Lo,
nl4-t Lgo
60
FT.
FT.
l,(o. -(c)
PLUMBING PERMIT
Plumblng Permit
State Surcharge
Total Charge
ADDITIONAL COMMENTS
By slgnature, I state and agree, that I have caref ully examlned
the completed application and do hereby certlfy that all
lnformation hereon is true and correct, and I further cerflfy
that any and all work performed shall be done in accorrlance
wlth the Ordinances of the City of Sprlngfield, and the Laws
of the State of Oregon pertainlng to the work descrlbed
herein, and that NO OCCUPANCy will be made of any
structure without permission of the Builcling Safety Divislon.
I further certify that only contractors and employees who
are in compliance with ORS 7O1.O5S will be used on thls
proiect.
I further agree to ensure that all required lnspections are
requested at the proper tlme, that each address ls readable
from the street, that the permit card ls located at the front
of the property, and the approved set of plans will remain
atu re
.d*
d^"
on the slte at imes during construction.
Wood Stove/ lnsert/ Flreplace Unit
Dryer Vent
MISCELLANEOUS PERMITS
Mobile Home
State lssuance
State Surcharge
Sidewalk _ ft
Curbcut tt
Oemoliilon
State Surcharge
(E)
N0
Total Mlscellaneous permit s
Vent Fan
(D)
MECHANICAL PERMIT
Furnace
Exhaust Hood
Mechanical Permit
lssuance
State Surcharge
Total Permit
TOTAL AMOUNT DU(A,B,qQandECo E (excluding electrical),mblned)
o95ry7
TJ
r?
1
VAI.IDATION
BECEIPT NUMBER
DATE PAID
AMOUNT RECEIVED
RECEIVED BY
C*60
ry____
RESIDENTIAL
PERMIT APPLICATION
lnspections: 726.3769
Office: 726-3759
LOCATION OF PROPOSED WORK:
ASSESSORS MAP:
LOT
PRIl\.GFIELD
/?oF2 7
/7 w ,4
.,OB NUMBER
225 Fifth Street
Sprlrrgf lelrJ, Oregon 97477
TAX LOT:o 37ooL
BLOCK:SUBDIVISION
7zc - ?roPl1()r.,JE:
//
1Vrfl ISTATE:ztPO/1-CITY:
lrrADDRESS:
OWNER:
ADDITION
rLDESCRIBE WORK:
DEMOLISH OTHERNEW- REMODEL
ADDRESSu0 EXPI}IES PHONECONTRACTOR'S NAME
MECHANICAL:
ELECTRICAL:
CONST.
CONTRACTOR #
GENERAL:
PLUMBING
Y OF BDRMS:
- OFFICE USE -
LAND USE:
WATER HEATER:
ZONING CODE:
FLOOD I)LAIN:
SECONDARY HEAT:
SOUARF. FOOTAGE:RANGE:
QUAD AREA:
I OF BLDGST
CONSTR. TYPE:
HEAT SOURCE:
# OF UNITS:
----
To request an inspectlon, you must call 726-3769. Thls ls a24hour recordlng. All lnspections requested before 7:00 a.m. will be
made the same worklng day, lnspections requested after 7:00 a.m. wlll be ma<Je the followlng work day.
REQUIRED INSPECTIONS
Temporary Electrlc Rough Mochanlcal - Prlor to
cover.
Flnal Plunrblng - When all
plumblng worl< is complete.
Slte lnspectlon - To be made
after excavatlon, but prior to
settlng forms.
Rough Electrical - Prior to Final Electrlcal - When all
electrical work is complete.cover
Underslab Plumblng/ Electrical /
Mechanlcal - Prlor to cover.
Electrlcal Servlce - Must be
approved to obtaln permanent
electrlcal power.
Final Mechanical - When all
mechanlcal work ls complete.
- After trenches are al Building - \rrihen allexcavated.Flreplace - Prlor to faclng
materlals and framing lnsp.
red lnspections have been
Masonry - Steel locatlon, bond
approved and building is
completed.
, groutlng Framlng - Prior to cover.
atlon - Alter forms are Other
but prlor to concrete WalltCelling lnsutatlon - Prlor toplacemont.cover.
Underground Plumblng - Prior
to filling trench.Drywall - Prlor to taplng
MOBILE HOME INSPE TIONSUnderlloor Plum!lng/ Mechanlcal
- Prior to lnsulatlon or decking.Wood Slovo - After lnstallation
Post and Beam - Prior to floor
lnsulatlon or decklng.lnserl - Aftor flre;rlace approval
and lnstallatlon ol unlt.
Blocking and Set.Up - When atl
blocklng ls complete.
r lnsulation - Prior to Plumbing Connections - When
home lras been connected to
water and sewer.
decking.Curbcut & Alrproach - After
forms are erected but prior to
placement of concrete.Sanitary Sewer - Prior to filling
trench.Electrical Connection - When
blocking, set-up, and plumbing
inspections have been approved
and the home is connected to
the service panel.
Storln Sewer - Prior to fllling
trench.
Sidewall< & Driveway - After
excavation is complete, forms
and sub-base material ln place..
Water Llne - Prlor to filling
trench.
Fenco - Wlren coi'rpleted.
Rough Plumblng - Prlor to
covor.
[--l Final - Atter all required\rr \nBpac\lons Bta epptoved
oorches. aklrting, cleGkE,
ventlng havo been lnstall
end
3nd
ed.E l-1 Strcct Trcer - When ell rsqulred
t-J itoes are Plantod'
rult-Tr
OCCY GROUP:
I OF STORIES:
E
E
tl
r
tl
tl
tl
E
tl
Lot faces
Lot sq. ftg.
Lot covorago
Topography
Total holght
Lot Typ€.
-
lntorlor
---.
Cclrtrclr
..-_ Panhandln
--- Cul-de-sac
Setbacks
P.L.}JSF-GAR ACC
N
S
'tl
IS THE PROPOSED WORK iN THE,
I.IISTORICAL DISTFICT, OR ON
TIlE IJISTORICAL REGISTER?
-
ll yos, tllls appllcatlon rnust bo slgnod
arrd approved by thc Hlstorlcal
Coordlnator prlor to permlt issuance.
APPFIOVED:E
VALUE
W
(A)
Main
Carport
ITEM
Garage
Total Value
Bullding Permit Fee
State Surchargc
Total Fec
--2"r7/.52s,l.sf
BUTLDING PERMIT
SO. FT. X $/SO. FT.
BUILDING VALUE, PLAN CHECK
AND BUILDING PERMIT
This pernrit is granted on the express condition that the said
construction shall, ln all respects, conform to the Ordinance
adopted by the City of Springfield, including the
Development Code, regulating the construction and use of
buildings, and may be suspended or revoked at any time
upon violation of any provisions of said ordinances.
3z,t )
z./4^24___
1*1rr'
ewed Ely
_1
DatePIans
Plan Check Fee:
Date Paid
Receipt Number:
Received
SYSTEMS DEVELOPMENT CHARGE (SDC)
(B)
Systems Development Charge is due on all undeveloped
properties within tlrc City linrits which are being improved.
ITEM
Flxtures
Besidential Bath(s)
Sanitary Sewer
Water
Storm Sewer
Moblle Home
FEE
rr--- --
FT.
FT.
(c)
PLUMBING PERMIT
Plumbing Permit
State Surcharoe
Total Charge
ADDITIONAL COMMENTS
By slgnature, I state and agree, that I have caref ully examlned
tlre conrploted appllcatlon and do hereby cerilly that all
lnformatlon hereon is true ancl correct, and I f urther certify
that any and all work performed shall be done in accordance
with the Ordinanccs of the City of Springfir,'ld, and the Laws
of the State of Oregon pertaining to the work described
herein, and that NO OCCUPANCY will be macJe of any
structure wlthout pcrrnission oI the Bulldlrrg Safety Divislon.
I further certify tlrat only contractors and entployees who
are In compliance with OFIS 701.055 wlil be used on this
proiect.
I further agree to ensure that all roquired inspections are
roquosted at tho propor tlmo, that oach address ls roaclable
from tho street, thal tho pcrmlt card ls locatocl at tho front
o( the property, and thc approved set of plans will remaln
Si0naturc
aDate
on tlre slte at all es durl onslructlon.
Wood Stove/ lnsert/ Flreplace Unit
Dryer Vent
MISCELLANEOUS PERMITS
Moblle Home
State lssuance
Stato Surcharge
Sldewalk .- ft
Curbcut __- ft
Demolitlon
State Surcharge
Total Miscellaneous perrnits (E)
N0Vent Fan
(D)
MECHANICAL PERMIT
Fu rnace
Exhaust l-loorj
Mechanical Permit
lssuance
State Surcharge
Total Permit
TOTAL AMOUNT DUE (exctuding electrical)(A, B, C, Q and E Combtned)
VAI-IDATION
FIECEIPT NUMBER
DATE PAIi)
AMOUNT RECEIVED
FIECEIVED BY --.*-,-
?
,
N'
OFEGO'VCITY OF SPR
225 FIFTE STREET approval
SPRINGFIELD' OREGON 97477 Zonins
INSPECTION REQTIBST:
0FFICE: 726-3759
1. LOCATION OF
DESCRI
JOB4 Ca t
5rI }FIELO
ELECTRICAL PERHIT APPLICATION
City Job Nunbe
0trl ?o tz7
\S I,BTE FBE SCffiDTILE BELOS
Residenti al-Single or
per dvelling unit.
ded:Items Cost
MuIt i-Fami ly
L000 .ft. or less
ditional 500
or portion
t
$ 8s.00
Ea ft
thereo $ 1s.00
Each Manuf'd llome. or
Modular Dvelling
Sertice or Feeder s 40.00
Services or Feeders
Ins tallation, Alterations
or Relocation:
726-3769
Date
t
sus
P
1H\S
OR\S
e and expire
ice Inc1u
Sum
Permits are non-transfera
if vork is not started vi
of issuance or if vork is
180 days.
for
)h
B
c
D
Ci ty
Supe
2. CO}IItsACf,OR INSTALI^ATION ONIY
Electrical Contractor
Address 200 amps or less
20L amps to 400 amPs
-
40L amps to 600 amPs
-
601 amps to 1000 amPs-
0ver 1000 amPs/volts
-
Reconnect OnlY
SUBTOTAL OF ABOVE
7% State surcharge
3Z Admlnistrative Fee
TOTAL
s s0.00
s 60.00
s100.00
$130. 00
$300.00s 40.00
/)---l-L:-
-T:]---v
rvisor L
Expiration Dat
Constr Cont Number
Expirat Date
s ure of SuPervising E Iectrician
Owners Name STar EJ
Address l lq(-/
Phone 7z[.7/o 6
Temporary Services or Feeders
Installaiion, Alteration or Relocation
200 amps"or less $ 40'00
over abt to 600 amps I $ 80'00
or"i oOO .rp" or-1500 ,ofts see rrBrr a666
Branch Circui ts ' .'
Nev, Alteration or Extension Per Panel
one circuit -l- g 3s.oo V f
Each Additional
-Each installation
Pump or irrigation
Sign/OutIine Lighting-
Limited EnergY/Res
-
Limited EnergY/Comm
OITNER INSTALI"ATION
The instatlation is being made on
property I ovn vhich is not intended
for sale, Iease or rent.
Ci ty
Ovners ture:
DATE:
Circuit or vith Service
or Feeder Permit 7 $ 2.oo 6
E. Miscellaneous (Service/feeder not included)
$ 40.00
$ 40.00
$ 20.00
s 36.00q/*
,,|1'2t
RECBIVED B
5
v
-*,11651i()(eUr
\\
#q1 ' tQ
0 to
,/
Issued by
o,Date: (
'
77
Statement: lnformation Notice to Property Owners
About Construction Responsibilities
Note; Oregon Law, ORS 701.055(4), requires residential construction permit appli-
cants who are not regislered with the Construction Contractors Board to sign the
following statement before a building permit can be issued. This statement is required
for residential building, electrical, mechanical, and plumbing permits. Licensed
architect and engineer applicants, exempt from registration under ORS 701.010(7),
need not submit this statement. This statement will be filed with the permit.
3,A'. My general contractor is
(Name) Contractor regis. #
I will instruct my general contractor that all subcontractors who work on the structure must be
registered with the Construction Contractors Board.
OR
M-38.I will be my own general contractor.
If I hire subcontractors, I will hire only subcontractors registered with the Construction Contractors
Board. If I change my mind and hire a general contractor, I will contract with a contractor who is
registered with the CCB and will immediately notify the office issuing this building permit of the
name of the contractor.
I hereby certify that the above information is correct and that I have read and do understand the Information
Notice to Property Owners about Construction Responsibilities on the reverse side of this form.
of permit applicant)
(l\hite copy to issuing ogency permit file,
pink copy to applicant)
(si (Date)
Permit #:
Address: / tt'/ U
Fill in the appropriate blanks and initial boxes I and2, and either box 3A or 38:
\-a,/
l)ff l.J own, reside in, or will reside in the completed structure.
'\fr {. I urd"rrtand that I must register as a construction contractor if the structure is sold or offered for sale
W before or upon completion.
7-
{
aa
---=-{E7Ur--!Fqtq;FrF,
lnformation Notlee to Prop*rty Owners
About Construction Hesponsibilities
Note: This Information Notice to Prapeny Ov,ners about Construction Responsibilities
v,as ttevelolterl hy the Crsnstruction Contr*cttsrs Board in accordunce with ORS 701.055{5}"
If you are acting aq your own contractor 10 consffuct a new home or make a substantial improvement to an existing sfruct*te.
you can prevt:nt nrany problenrs by being aware of the following responsibilities and areas of concem.
If you hire persons not registered with the Construcfion Contractors Board to do labor in constructing or assisting in the
construction or improvement of a residentinl strxctue, you will. in most instances, be ruled to be an employer and the people
you hire will be employees. As the employer, you must comply with the following:
Oregan's withholding tax lawl As an employer, you must withhold income ta,xes from employ.oe wages at the ti:ne employees
nre paid. Y<ru will be liable for the [ax payrnents even i] you don't actuaily withhold the t;Lx from your employees. For more
infbrmation, call the Oregon Dept. of Revenue at 945-8091.
Unenrployment insumnee tax: As an employer, you are required to pay a tax for unemployment insurance purposes on the
wagesr:faIlemployees.Farnroreinfonnatirrn,ca.I1the0regorrEmployrnentDepar1rnent*l378.3524.
Worker's compensation insurance: As an employer, you are subject to the Oregon Wrlrkers' Compe*sation Law, and musf
obtain workers' compensation insurance for your employees. Il you fail to obtain workers' compensation insurance. you may
be subject to penalties and wj"ll be liable for all claim costs if one of your employees is injured on the job. For rmne informafiixn,
call the Wcrr*ers' Compe631i6n Division at the Department of Consumer and Business Services at 945-7{tt}8.
U.S.In&rnal Revenue Service: As an employer, you must withhold federal income ta"r ftom employees'wages.You will be
Iiable for &e tax paymeff even if you didn't actually withhold the tax. For morc information, call the hrternal Revenue Service
ar 1-800-829-1040.
Code compliance: As the permit holder for this project, ya$ are responsible for resolving any failure to meet code
thar may be brought to yo*r attention through inspections.
requinx:Ents
Liability and pntperty dnmage insuran*e: Contact your insurance agen{ tu sec if you hav* adcquate insur:mce coveragc f'or
accidents and omissions such as falling tools, paint overspray, water damage &orn pipe punctureso fire, or work that musl be
re-done.
firne ta supervire employees: Make sure you have sufficie*t time to supervise our employees.
Expertise: Make sure you have the expe*ise to act a"s your o\vtl genernl contractor, to ccrrdinale the work of ror"lgh-in and finistr
trades, and to notify building o{licials at the appropriate tirnes so they can perfcrrxr the required inspections.
If you have atlditional questions, write or call the Construction Contractors Board (PO Box 141N, Salim, OR 973CF)-5052,
543878-4621). The Board is located at 700 Summer St. NE Suite 300, in Salem
prop-ox,n"pm4
U94